*Purpose: Increased recipient age has been associated with poorer solid organ pancreas transplant (SOPTx) outcomes. We hypothesized that recipient age cut-offs in Australia and New Zealand (<50 years old) are low compared to similar cut-offs worldwide and performed a systematic review and meta-analysis to examine the effect of increased recipient age on SOPTx outcomes based on our cut-offs.

*Methods: OVID Medline, Embase and the Cochrane Library were searched for observational cohort studies assessing association between increased recipient age (≥50 years old) in adult SOPTx recipients with 1 and 5-year pancreas and kidney graft survival and patient survival respectively. Islet-cell transplant studies were excluded. Event rates were extracted and pooled when >2 studies/outcome were identified. Data extraction and risk of bias assessment (Newcastle-Ottawa Scale) was performed by 2 authors independently. Outcomes were summarised and presented via the Grading of Recommendations Assessment, Development and Evaluation (GRADE). 4670 records were identified, 3719 records entered title/abstract screening and 52 records were assessed by full-text screening. Fourteen studies were included for qualitative synthesis, with 7 studies further analysed via meta-analysis.

*Results: Meta-analysis showed no significant difference between groups for all outcomes apart from 5-year patient survival, where the older recipient cohort had worse outcomes (Table 1). Sensitivity analysis excluding high risk of bias studies was performed for the outcomes of 1-year pancreas graft and patient survival which also showed no significant difference between groups. Sensitivity analysis was not performed for the other outcomes as this would have limited the number of studies from being pooled for meta-analysis. Seven other studies comparing SOPTx outcomes in older vs standard age recipients were reviewed qualitatively with age cut-offs of 50 (n=2), 55 (n=4) and 60 (n=1). Apart from 1 study showing inferior 10-year patient survival in the older recipient cohort, all other studies showed no difference in outcomes between groups.The GRADE level of evidence was LOW/VERY LOW overall. Limitations are the inclusion of studies in abstract form and the effect of possible selection bias of the older recipients. Strengths are the lack of similar prior systematic reviews in pancreas transplantation.

*Conclusions: Current literature suggests no significant difference in 1, 5-year graft survival and 1-year patient survival for selected recipients ≥50 years old compared to <50 years old. However long-term patient survival appears worse in older recipients.

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